Preseed.com Blog

An excellent review article was just published from our good colleagues at the Cleveland Clinic,  “Role of antioxidants in the treatment of male infertility” by JC Kefer, A Agarwal & E Sabanegh, International Journal of Urology (2009) 16, 449–457.

The paper nicely reviews some of the external sources of reactive oxygen species (ROS) that can negatively impact male fertility.

Specifically addressing:

• Industrial compounds:  “For example, the compound phthalate is found in a broad spectrum of plastics used in food packaging, as well as beauty products and exposure to this chemical can occur via oral, skin, or inhalational routes. Phthalate exposure has been shown to cause DNA damage in sperm, as well as impaired spermatogenesis.”
• Cigarette smoking:  Not surprisingly, men who smoke have decreased sperm quality, including “decreased sperm counts, motility, and morphologically normal sperm”.
• Exercise-induced oxidative stress:  Both lack of exercise and intensive levels of exercise have both been shown to generate high levels of oxidative stress and may interfere with sperm production. “For example, Manna et al. have described in a rodent model that increased levels of exercise correspond to a reduction in sperm quality and testicular function, including decreased sperm counts, testosterone levels, and testicular oxidative stress”. 
• Elevated temperatures:  Men with a fever showed a 35% decrease in sperm concentration, a 7% decrease in normal morphology, and a 20% increase in immotile sperm following febrile episodes. Also, these parameters worsened with increased duration of the febrile episodes. “Tiemessen et al. examined the relationship between underwear style and intrascrotal temperatures, and hypothesized that scrotal hyperthermia due to tight-fitting underwear may cause decreased sperm parameters. The authors followed 20 patients wearing loose-fitting underwear for 6 months and tight underwear for 6 months with semen samples analyzed every 2 weeks for one year.  Although 50% of patients did not complete the study, the results nonetheless demonstrated an approximately 50% decrease in sperm parameters in the group wearing the tight-fitting underwear, which improved after switching to loose underwear. This rapid reversal of sperm parameters following cessation of tight-fitting underwear is encouraging, and may be useful in the counseling of the infertile male.”

This paper goes on to have an excellent review of the studies evaluating the impact of antioxidant vitamins on sperm quality for trying to conceive men.  Fertility vitamins such as FertilAid for Men, have these antioxidants in them and are probably a good choice for most men to take while trying to conceive.

Cheers ~
Dr. E

Should men with poor semen quality, or any TTC man, take vitamin supplements, in particular vitamins designed to “support” fertility?  The rationale behind this is that most men with low fertility have very low levels of antioxidants in there semen.  Antioxidants (like Vitamins C & E, as well as others) protect cells from damage.  Sperm from men with low antioxidants in their semen can have a breakdown of the DNA, or genetic material in the sperm, and it may be a reason for some infertility.  So taking vitamins, especially those blended to support antioxidants in semen should be a straightforward approach.  

However, the study outcomes in this area are confusing.  This has led some doctors to recommending people to not take vitamins.  This is throwing the baby out with the bath water—for sure!  To summarize, fertility studies can be hard to do because there are so many reasons for couples to not conceive.  It is kind of like asking “what is the best cure for cancer?”, without knowing what kind, how long etc… you simply can not answer this.  In addition, antioxidants are tricky, more is not better.  You can OVER supplement and this can CAUSE sperm damage.

In spite of the difficulties in getting a study that says – “ a man with this kind of sperm defect needs to take this kind of vitamin”, in general, TTC people should take a supplement.  This is because nutrients have declined in many plant crops over the last 50 years (http://www.sciencedaily.com/releases/2004/12/041203100522.htm), this is likely even more true for trace minerals that are critical for normal reproduction that weren’t measured 50 years ago (Zinc…).  As a former veterinarian, I always thought it was interesting that we feed our animals less processed grains than we eat (corn, soybean etc…), but all the feeds add trace minerals and vitamins, to optimize the animals function, including reproduction.

Taking a vitamin blended for TTC folks, is a good place to start getting some of the nutrients associated with improved sperm count, without going over board and causing damage.  There are several products out there (FertilAid for Men, Fertility Blend etc…).  However, I did want to share with you all a study that our Company did on sperm quality in men after taking FertilAid, versus a placebo.  The study was done under contract with the manufacturer, Fairhaven Health, but our company retained the rights to disclose the data no matter the outcomes, meaning we had no incentive to find a favorable outcome.  

This 90-day, double blind, placebo-controlled study found that FertilAid for Men supported an increase in the total number of normal motile sperm, in the ejaculate.  Most of the men that had increased sperm counts while taking FertilAid for Men, showed improvements of 20% or more in the number of healthy sperm.  Previous clinical studies have suggested a relationship between the “total normal-motile sperm count” in an ejaculate and the fertility of the man.  Specifically, the greater the number of normally shaped sperm that are able to swim (motile),  the higher the incidence of pregnancy among trying-to-conceive couples. 

There aren’t many simple things to do to help men with poor sperm quality.  Taking a vitamin/antioxidant supplement for at least 90 days, to see if sperm counts and function can be improved… Why not!!!   We have put a manufacturer’s mail-in rebate for FertilAid in our Pre~Seed cartons to help remind people to take their vitamins   Let me know how they work for you.

You can learn more about this product at Fairhaven Health (http://www.fairhavenhealth.com), a leading manufacturer of fertility products for both women and men. 

Take Care-

Dr. E

Inseminating sperm directly into the uterus (intrauterine insemination or IUI) is often used in male factor infertility, either with or without giving medication to stimulate the ovaries.  There have been a couple of papers this year of interest to me on this topic.  Many couples don’t fully realize how low the per cycle pregnancy rate with IUI can be, especially in conditions as noted below, or in clinics that aren’t very experienced in dealing with male factor patients (read more of my FAQs to learn about this).

Specifically, Badawy et al., 2008 showed declining pregnancy rates following IUI with  male factor if: the female partner was over 35 yrs old; the number of motile sperm inseminated was less than 5 million ( a 5.5%, pregnancy rate versus 24% if there were more than 5 million motile sperm); or if normal sperm morphology  (WHO guidelines) was under 30%.    Another recent study (Dovey et al., 2008) with over 4,000 couples found pregnancies from women under 35 years of age at 11.5% per cycle.  Women 35-37 had a pregnancy rate of 9% , which declined down to 1.8% in women over 42.  

This is why we recommend if you are 35 or older, do not wait for one year without conceiving to get assistance!

Many people do not believe that a doctor’s intervention is the right thing to do in conceiving, or perhaps they just can’t afford it.  It is interesting to note that although the percentage of women having a baby tends to be higher following intra-uterine insemination,  it has not been able to be proven to be more effective in clinical studies versus well timed natural intercourse (Cochrane Database Syst Rev., 2007 ).  This is likely due to the lack of well designed studies, rather than an ineffectiveness of IUI (done by experienced clinicians), BUT it does suggest that good old, natural love making at least every other day throughout your ovulation time, can be effective even after a long time of trying!  So even if you can’t or won’t do IUI, keep timing your ovulation and keep love making  “that time” as enjoyable as you can! Sometimes miracles do happen

Dr. E

PS: I will continue my male work-up series later this month!
 

A unique study was recently done evaluating the effects of either Viagra or Cialis on sperm motility in INFERTILE men ages 32- 39, after a ONE time dose on a semen sample taken 1-2 hours later (see bottom of the post). This study found that the average percent of motile or swimming sperm went up from 28% for controls (no meds) to 37% with the Viagra, and down to 21% with the Cialis.

Why is this study important?
1) They used younger infertile men. This is the exact population that occasionally needs a little “help” to deliver a good semen sample for assisted reproduction, or semen analysis, or during intercourse at home– who may be having “burn out” from the stress of Sex on Demand at ovulation.
2) They used one dose of the meds, like a couple might want to do to make sure there are no ED issues or stress at a critical time- again either for a fertility test or procedure, or on key days at home.
3) Viagra significantly increased average sperm motility and took it almost to a normal level (40% motile or higher is normal).

Discussion: Many, many couples who are having trouble conceiving end up with male performance issues due to a variety of reasons. This is far more common than you would think, and than your doc will tell you about – mostly because few couples tell their physician about this. These issues include: stress of sex on demand, having to have frequent intercourse (without time for a build up of desire), having to perform for a procedure or test. Ladies, imagine what it would be like if conceiving a child REQUIRED you to orgasm on a certain day!!! You can see why our men get stressed!

If performance issues arise (where DH can’t get the job done at a critical time), it can really make a couple sideways and puts even more stress on him the next time around. I have received many emails from couples where baby-dancing during a peak fertile day ended up in tears !

If you are experiencing this, or are worried about it for a big fertility procedure, ask your doctor for a one time dose of Viagra (some studies have shown chronic use may affect other types of sperm function).

Also, be sure and keep things slippery and fun for intercourse with Pre~Seed, or for manual semen collection with Pre’. The more he is stimulated the better semen sample he can produce. And part of proper stimulation is a well lubricated experience- it really does matter!

Dr. E

Fertil Steril. 2007 Oct;88(4):860-5. Epub 2007 Jun 4. Links
Alterations in sperm motility after acute oral administration of sildenafil or tadalafil in young, infertile men.Pomara G, Morelli G, Canale D, Turchi P, Caglieresi C, Moschini C, Liguori G, Selli C, Macchia E, Martino E, Francesca F.
Urology Unit, Azienda Ospedaliera Pisana, University of Pisa, Pisa, Italy.

OBJECTIVE: To evaluate the acute effect of sildenafil and tadalafil on seminal parameters in young, infertile patients. DESIGN: Prospective, randomized, double-blind, crossover clinical investigation on semen parameters after the administration of a single dose of sildenafil (50 mg) or tadalafil (20 mg). SETTING: An academic hospital as well as a male infertility center and clinical andrology laboratories. PATIENT(S): Eighteen young, infertile men. INTERVENTION(S): Oral administration of a single dose of sildenafil (50 mg) or tadalafil (20 mg) in a blind, randomized order. The semen samples were collected 1 or 2 hours after each treatment. MAIN OUTCOME MEASURE(S): Changes in sperm parameters after sildenafil and tadalafil administration, compared with the basal conditions. RESULT(S): A significant increase in sperm progressive motility (median value, 37.0% vs. 28.5%) was observed after sildenafil administration as compared with baseline; in contrast, a significant decreased value was observed after tadalafil (median value, 21.5% vs. 28.5%). CONCLUSION(S): These preliminary results indicate that sperm motility appears to be acutely affected in young, infertile patients by a single dose of sildenafil and tadalafil, with opposite effects: stimulatory by the former and inhibitory by the latter.

I just received an advanced copy of a meta-analysis study done at Cleveland Clinic on whether or not surgical repair of varicoceles increases spontaneous pregnancy rates. This data will be in ob/gyn Perspectives Fall 2007 . It looked at results from 5 different well designed studies and found that 33% of couples following surgery became spontaneously pregnant, while only 16% did without repair.

The authors concluded “Surgical varicocelectomy in infertile men with palpable lesions and at least one abnormal semen parameter improves the odds of spontaneous pregnancy”. I very much agree with these findings, in particular because varicoceles increase the percentage of sperm with damaged DNA or genetic material, and repairing the problem allows DNA damage of sperm to lessen for most men.

Often medical clinics that promote no repair are those that heavily push for assisted reproduction to obtain pregnancy. I am much more a fan of trying to fix a problem in the man, to support as many natural pregnancies as a couple wants-with proven safer outcomes for all!

Dr. E